Category Archives: issue

Current Concepts and New Trends in the Treatment of Cardiogenic Shock Complicating Acute Myocardial Infarction

Theodora Benedek, Dan Dobreanu

University of Medicine and Pharmacy of Tirgu Mures, 38 Gheorghe Marinescu street Tirgu Mures, 540139, Romania

DOI: 10.1515/jccm-2015-0002

Cardiogenic shock (CS) is a critical condition which often complicates the evolution of an acute myocardial infarction (AMI). At the same time, co-existence of chronic multi-vessel disease can lead to the development of cardiogenic shock in cases with pronounced haemodynamic instability. Different clinical studies have tried to identify the most appropriate treatment for critical cases of CS complicating AMI. This review aims to present the current status of recommended therapeutic strategies for severe cases of CS presenting as a complication of AMI, and try to shed light on the most appropriate therapeutic strategy as outlined in the current literature. The paper will discuss the different current strategies available for use in the treatment of this condition, includig interventional revascularisation, (complete or culprit), the role of new devices for providing mechanical circulatory support, and the potential role of new drug therapies and of hypothermia.

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The Value of the “Lab-Score” Method in Identifying Febrile Infants at Risk for Serious Bacterial Infections

Diana Aniela Moldovan1,2, Maria Despina Baghiu1,3, Alina Balas2, Sorana Teodora Truta1,2

1 University of Medicine and Pharmacy of Tirgu Mures, Gheorghe Marinescu street no.38, Tirgu Mures, 540139, Romania

2 Tîrgu Mures County Clinical Emergency Hospital, Emergency Department, Gheorghe Marinescu street no.50, Tirgu Mures, 540136, Romania

3 Tîrgu Mures Emergency Clinical County Hospital, Paediatric Clinic, Gheorghe Marinescu street no.50, Tirgu Mures, 540136, Romania

DOI: 10.1515/jccm-2015-0003

Introduction: Most children with fever without source will have a self limited viral infection though a small percent will develop a serious bacterial infection (SBI) like urinary tract infection, pneumonia, bacteraemia, meningitis or sepsis. The challenge facing practitioners is to distinguish between these two groups and currently biomarkers, like C-reactive protein (CRP) and Procalcitonin (PCT), are available for this purpose.
The aim of the current study was to identify SBI in infants with fever without an identifiable cause using the recently introduced “Lab-score” combining C-reactive protein, procalcitonin and urine dipstick results.
Methods: This survey is part of an observational study aimed at identifying children with fever without source at risk of SBI. Patients were recruited from the Emergency Department of Tîrgu Mures Emergency Clinical County Hospital, Romania, during 2013. SBI diagnosis was based on urine, blood and cerebrospinal fluid cultures and chest radiographs. For infants, aged 7 days to 12 months, CRP and PCT were determined and the “Lab-score” was calculated. Positive and negative likelihood ratios and post test probabilities were calculated for each parameter and score.
Results: Of the ninety infants included in the study, SBI was diagnosed in nineteen (21.11%). Ten had a urinary tract infection, seven had pneumonia, one had a urinary tract infection and bacteraemia, and one had sepsis. Positive and negative likelihood ratios for CRP (≥40.0 mg/L) and PCT (≥0.5 ng/mL) were 10.27/0.45 and 7.07/0.24 and post-test probabilities 73%/65%. For a “Lab-score” (≥3), positive and negative likelihood ratios were 10.43/0.28, and the post-test probability was 73%.
Conclusions: In our survey the “Lab-score” proved a strong predictor for the identification of febrile infants at risk of SBI, but showed no significant difference compared with CRP and PCT which both proved equally good predictors for SBI.

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Critical Thinking for Critical Care

Leonard Azamfirei, Editor-in-Chief

University of Medicine and Pharmacy of Tirgu Mures, 38 Gheorghe Marinescu street, Tirgu Mures, 540139, Romania

DOI: 10.1515/jccm-2015-0001

It is a great privilege to introduce the Journal of Critical Care Medicine, a new international publication aiming to promote the dissemination of scientific information in the treatment of the critical ill.
The JCCM, a multidisciplinary journal, will publish high-quality scientific papers covering different aspects related to the care of critical ill patients covering a broad spectrum of therapeutic disciplines, such as general surgery, perioperative care, cardiology, internal medicine, pneumology, infectious diseases, organ transplantation, emergency medicine or neurology.
Critical care medicine is a rapid expanding field. Recent progress in medical science and technology has led to a significant increase in the number of patients with life-threatening conditions who can benefit from increasingly wide-ranging monitoring and care. Significant resources are nowadays invested in the complex effort to discover and develop new approaches dedicated to improve the progress of these patients and to ensure a fast clinical and functional recovery.
In Central and Eastern European countries, complex strategies are required to align critical care models to the best current standards of care on international level. There is an obvious need, for a new journal dedicated to the exchange of information within the medical community dedicated to treating the critically ill. The necessity for a such a journal arises not only from the high relevance of the topics covered, but also from the paucity of journals in this part of Europe, dedicated to subjects relating to the critical ill. The JCCM will address these needs with specific regard, but not exclusively, to those of Central and Eastern European countries.  [More]

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